| NPI | 1063879187 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE ALAN TRICKEL Administrator 229-438-3368 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine |
| Enumeration Date | 2016-01-20 |
| Last Update Date | 2016-01-20 |